Parkinson's disease Flashcards
Three drug classes that can be used in early PD
levodopa
non-ergot-derived DA receptor AG
MOBIs
What is a caution of using antiparkinsonian drugs in the elderly
can cause confusion - titrate slowly
Name 4 DA receptor Ags, why are these ones used?
Pramipexole
Ropinerole
Rotigatine
(use these instead of ergot derived as those are associated with fibrinolytic reactions)
How dose the side-effect profile of DA receptor agonists differ to levodopa
fewer movement disorders but more psychiatric side-effects
What adding a DA receptor Ag to levodopa what should you do to the levodopa
reduce dose
What class is apomorphine when is it used
DA receptor Ag
Used in later disease, for pt experiencing unpredictable off periods with levodopa
What is the mode of admiistration of apomorphine
SC IJ
What are the MHRA cautions with DA receptor Ag & Dopamine precursors
Impulse control disorders - gambling, binge eating, hypersexuality
2 reasons levodopa is given with an extracerebral peripheral dopa-decarboxylase inhibitor
Reduces peripheral conversion of levodopa -> dopamine
- limit s/e such as nausea, vom, CV effects
- effective brain conc achieved with lower dose
What antiemetic can we use for N&V side-effects of levodopa
domperidone
Motor complications with levodopa therapy are more common in the young or old
young
end of dose deterioration can be reduced with what formulation
MR
Name 2 MAOBI
rasagiline
selegiline
(when used in early disease may delay need for levodopa therapy)
Why are antimuscurinics not given in idopathic PD (2)
not as effective as DA
Associated with cognitive impairment
When would you use the antimuscurinic drugs such as orphenadrine, procyclidine and trihexyphenidyl
parkinsonism induced by antipsychotic drugs (but it does not help tardive dyskineasia, may make if worse)
If treatment with an antimuscurinic is ineffective what can be used for life threatening drug induced dystonic reactions
diazepam
Tertrabenazine is used for
movement control disorders in huntingtons
works by depleting nerve endings of dopamine
(antipsychotics are also used)
Propanolol is used to treat 2 types of termor
essential
thyrotoxicosis induced
Dopamine precursors may cause what in the day time
sudden onset of sleep
MHRA alert on bromocriptine, cabergoline and pergolide (2)
Ergot derived DA Ags
-Impulse control disorder
-Fibrinolytic reactions
(pulmonary, retroperitoneal & pericardial - monitor for dyspnoea, persistant cough, chest pain, cardiac failure, abdo pain)
